Wednesday, December 3, 2008

A good doctor should first show he or she is good person; here's checklist for physician with right stuff

My long journey into the health care system began almost three years ago on Dec. 15, 2005.

On that day, I learned I had the worst form of leukemia at the age of 47. While knowing I had the disease was bad enough, the way I learned of it was just as devastating.

I had been taken downstairs at the Nashville hospital to have a CAT Scan. While waiting next to the giant machine, a doctor I'd never met before came in and simply told me I had leukemia. And that was it. "Have a nice day".

My doctor should have told me the bad news, with my wife at my side. Instead, I next had to sit still for a CAT Scan and not breathe while holding back tears at the thought of my life soon coming to an end.

Thankfully, I later was assigned to Vanderbilt Medical Center after my first two rounds of chemo at the first hospital did not put me into remission. And it was at Vanderbilt that I met Dr. John P. Greer, Dr. William Gregg and a host of other doctors and nurses who have treated me with such kindness, telling me I mattered.

Today's New York Times, in an article by a psychiatrist, examines the problem of doctors too often not acting like caring human beings. The next time you have to go to the hospital or for a doctor visit, carry a copy of this blog post and hand it to your physician if they act like they don't really have the time for you or the respect to listen.

Here is an excerpt from the article:

But as I noted last May in an article in The New England Journal of Medicine, medical schools may be underemphasizing a much simpler virtue: good manners.

In the article, I described a common-sense method for spreading clinical courtesy that I call “etiquette-based medicine,” and I proposed a simple six-step checklist for doctors to follow when meeting a hospitalized patient for the first time:

• Ask permission to enter the room; wait for an answer.

• Introduce yourself; show your ID badge.

• Shake hands.

• Sit down. Smile if appropriate.

• Explain your role on the health care team.

• Ask how the patient feels about being in the hospital.

Do doctors really need to be told to do such obvious things? Unfortunately, anyone who has spent time in the hospital as a patient or a physician knows how haphazardly such actions are performed, and as Samuel Johnson wrote, “Man needs more to be reminded than instructed.”

There is a useful analogy here to raising children. The British physician D. W. Winnicott coined the term “good enough mother” in part to help mothers who were overly anxious about their parenting skills. Rather than worry about trying to be perfect (whatever that meant), he urged them to relax, trust their intuition and realize that their children needed a mother who was caring, alert and reliable — in other words, good enough.

Similarly, when medical schools try to turn out ideal doctors, they can miss the opportunity to help them be good enough: perhaps not perfectly attuned to the patient, but at least respectful and professional. An etiquette-based approach can promote such behavior.

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